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51 Cards in this Set

  • Front
  • Back
ADHD pathophysiology
1)deficiency of NE and DA at synapse in frontal and neostriatial systems
-accounts for phasic patterns of symptoms
What are the 3 main symptoms of ADHD? (ADHD TRIAD)
1)inappropriate inattention
What is the first treatment option for children with ADHD?
1)Non-pharmacologic therapy
-education, behavioral therapy
What is the first line class of agents for ADHD?
central nervous system stimulates
What is the next step if one agein in the class fails?
Try another stimulant agent
CNS stimulants MOA
1)increases release of DA and NE from presynaptic nerve
2)inhibit reuptake of DA and NE
3)inhibit MAO
What types of CNS stimulants should you start out with?
Short-acting CNS stimulants (BID-TID)
Generic for Adderall
Generic for Ritalin
Generic for Dexedrine or Dextrostat
What is the initial daily dose of methylphenidate?
1)0.3mg/kg/dose BID to TID
2)3-5yrs = 5mg
3)=>6 = 10mg
What is the maximum dose for Adderall
1)3-5yrs = 40mg
2)=>6yrs = 40mg
What is the maximum dose for Ritalin?
This long-acting stimulant is a patch that is intended for 9 hours of wear and can be found in the blood stream for up to 3 hours after removal. It also takes 2 hours to take effect.
Daytrana (methylphenidate)
This long-acting stimulants side effect includes a tablet form expelled from the stool
Concerta (methylphenidate
Side effects of CNS stimulants
2)decreased appetite (increased prevelance w/long acting agents)
3)insomnia ('')
4)exacerbate tics
5)delayed growth (drug holidays)
6)increase HR and BP
7)patch can irritate skin
Contraindications to stimulants
1)pre-existing cardiac abnormalities
4)suicidal thoughts?
What are 7 other drugs/classes of agents that can be used only if stimulants fail or are contraindicated?
6)alpha-adrenergic agonists
7)atomoxetine (Strattera)
pemoline MOA
dopamine agonist w/ long t1/2 allowing for QD dosing
advantages of pemoline
1)similar efficacy
2)schedule IV controlled substance
disadvantages of pemoline
1)fulminant hepatic failure (LFT monitoring is NOT predictve---BLACK BOX WARNING----
disadvantages of TCAs
1)side effect profile
2)must titrate on and off
3)desipramine may place child at cardiac risk
bupropion disadvantages
1)exacerbated tics
2)not FDA approved
venlaxafine MOA
inhibits reuptake of NE and 5-HT
venlaxafine side effects
1)mild nausea most common
2)increase in blood pressure that is dose dependent
what alpha-adrenergic agonists have been used with success?
clonidine and guanfacine
atomoxetine MOA
1)Selective NE reuptake inhibitor
atomoxetine side effects
atomoxetine drug interactions
1)metabolized via CYP P450 2D6 pathway
-7% of population are poor metabolizers
atomoxetine dosing
1)1-2mg/kg/day in pediatrics
2)adults should not exceed 100mg/day
What is the definition of tourette's d/o?
A chronic familial d/o characterized by multiple MOTOR TICS with one or more VOCALIZATION TIC
Examples of motor tics
twitching, jerking, rapid mouth movements, rapid muscle movements
Vocal tics
-phonic tics
1)98% have phonic tics
2)<30% have coprolalia
How is tourette's d/o diagnosed?
must have tics for 1yr or more for diagnosis
What is the age of onset?
What is first line therapy for Tourette's d/o?
behavioral and psychotherapy
What 3 agents have shown efficacy in tourette's d/o?
3)clonidine (less effecive)
Which agents for tourette's d/o cause EPS?
haloperidol and pimozide
Clonidine MOA
1)reducs sympathetic ouflow via stimulation of alpha-2 receptors in CNS
2)acts as an adrenergic agonist
What is the difference between primary and secondary enuresis
primary enuresis indicates the child has never established urinary continence, secondary follows an established period (3-6months) of urinary continence
What is the initial therapy for enuresis?
1)education is key
2)discourage punishment
3)behavioral and condiationing methods
What are examples of behavioral and condiationing methods?
1)bed alarms
2)no fluids after 6
3)set wake up patterns to void
-may take up to 3-4months but 70% effective
If drug therapy is initiated, attempts to d/c should be made every _____ to assess for spontaneous remission
What is the efficacy of imipramine?
-half will have complete resolution, half will have decreased number of episodes
imipramine dosing issues
1)initial 25mg QHS w/ increases of 25mg/week if needed
2)avg dose is 75mg in children and 150mg in teens
3)initially effect dose will become ineffective in 2-6weeks. Dose will need to be titrated up to reestablish control
Alternative agent for enuresis
Desmopressin acetate (DDAVP)
Efficacy of DDVAP
2)better results in children over 9years
3)duration of effect is 6-24hours
What is the dose (intranasal) for DDAVP ***KNOW***
1)20mcg QHS which can be increased to 40mcg after 3 nights if success is not seen
2)half of dose is given in each nostril
DDAVP adverse effects
1)nasal irritation
What is a very important counseling point with DDAVP?
evening fluids should be limited to 8ozs to prevent hyponatremia or water intoxication
What is the treatment for Munchausen's syndrome by proxy?
remove child from the home until parent undergoes psychiatric evaluation